Pre-transplant depression decreased overall survival of patients receiving allogeneic hematopoietic stem cell transplantation: a nationwide cohort study

Abstract

Studies investigating association of depression with overall survival (OS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) yielded conflicting results. A nationwide cohort study, which included all adult patients [n = 7,170; depression group, 13.3% (N = 956); non-depression group, 86.7% (N = 6,214)] who received allo-HSCT from 2002 to 2018 in South Korea, analyzed risk of pre-transplant depression in OS of allo-HSCT. Subjects were followed from the day they received allo-HSCT, to occurrence of death, or last follow-up day (December 31, 2018). Median age at allo-HSCT for depression and non-depression groups were 50 and 45 (p < 0.0001), respectively. Two groups also differed in rate of females (depression group, 55.8%; non-depression group, 43.8%; p < 0.0001) and leukemia (depression group, 61.4%; non-depression group, 49.7%; p < 0.0001). After a median follow-up of 29.1 months, 5-year OS rate was 63.1%. Cox proportional-hazard regression evaluated an adjusted risk of post-transplant mortality related to depression: OS decreased sequentially from no depression (adjusted hazard ratio [aHR] = 1) to pre-transplant depression only (aHR = 1.167, CI: 1.007–1.352, p = 0.04), and to having both depression and anxiety disorder (aHR = 1.202, CI: 1.038–1.393, p = 0.014) groups. Pre-transplant anxiety (anxiety only) did not have significant influence in OS. Additional medical and psychiatric care might be necessary in patients who experienced depression, especially with anxiety, before allo-HSCT.

Psychosocial aspects of hematopoietic stem cell transplantation

“…A number of investigations have explored the impact of psychosocial risk factors on transplant-related mortality and morbidity, with conflicting results[ 18 , 25 , 26 ]. In a recent study, pre-transplant depression, particularly with comorbid anxiety, decreased the overall survival time after transplantation, while pre-transplant anxiety without depression had no impact on transplant-related mortality[ 27 , 28 ]. Psychological distress prior to HSCT is more likely to be manifested as severe anxiety than as depressive symptoms[ 13 , 29 ].…”

Development and validation of a comorbidity index for predicting survival outcomes after allogeneic stem cell transplantation in adult patients with acute leukemia: a Korean nationwide cohort study

“…In Korea, the Korean National Health Insurance Service (KNHIS) program is a mandatory public health insurance system that covers approximately 98% of the overall Korean population. The KNHIS database contains universal medical claims and mortality for the entire Korean population [11] and has been used in various epidemiological research studies on hematologic diseases, as described in detail elsewhere [12][13][14][15]. These strengths enable research on a nationwide cohort with the endpoint of identifying personal comorbidities related to patient prognosis after alloSCT.…”

Leukaemia Cutis: Clinical Features and Outcomes of 56 Patients

“…Leukaemia is a life-threatening malignant neoplasm of the haematopoietic system ( 1 , 2 ). After a generalization phase in bone marrow and the appearance of leukaemic cells in the peripheral blood, extramedullary manifestations can occur in any organs of the body, including the skin ( 2 ).…”

“…Leukaemia is a life-threatening malignant neoplasm of the haematopoietic system ( 1 , 2 ). After a generalization phase in bone marrow and the appearance of leukaemic cells in the peripheral blood, extramedullary manifestations can occur in any organs of the body, including the skin ( 2 ). Findings in the skin of leukaemia patients are common and varied, such as nodular lesions, plaques, hyperpigmentation ( 3 , 4 ) or vasculitis ( 5 ).…”

“…Findings in the skin of leukaemia patients are common and varied, such as nodular lesions, plaques, hyperpigmentation ( 3 , 4 ) or vasculitis ( 5 ). Non-specific cutaneous manifestations are mostly associated with abnormal haematopoiesis, such as thrombocytopenic purpura, incompetent granulocytopoiesis causing opportunistic infection including herpes zoster or fungal infection, and cutaneous paraneoplastic disease including pyoderma gangrenosum and insect-sting-like skin changes ( 2 , 6 , 7 ).…”